A Comparison of TULSA Procedure vs. Radical Prostatectomy in Participants With Localized Prostate Cancer
- Conditions
- Prostate CancerProstate Adenocarcinoma
- Registration Number
- NCT05027477
- Lead Sponsor
- Profound Medical Inc.
- Brief Summary
Men with localized, intermediate risk prostate cancer will be randomized to undergo either radical prostatectomy or the TULSA procedure, with a follow-up of 10 years in this multi-centered randomized control trial. This study will determine whether the TULSA procedure is as effective and more safe compared to radical prostatectomy.
- Detailed Description
The typical standard of care for patients with localized, intermediate risk prostate cancer is radical prostatectomy, which involves the surgical removal of the prostate. Although radical prostatectomy is effective in terms of controlling the cancer, it may leave men with significant long-term effects in urinary, sexual function like erectile dysfunction and/or incontinence (loss of bladder control), thus reducing quality of life. Preservation of continence (ability to control your bladder) and potency (ability to achieve erection and/or ejaculation) may be significant concerns for men.
Targeted ablation of localized prostate cancer using MRI-guided technology is becoming a favorable option for many men who wish to have their cancer treated but do not wish to compromise their urinary and sexual functions. The TULSA Procedure is a new, minimally-invasive technique that uses real-time MRI-guided technology to guide the delivery of high-energy ultrasound to precisely, and in a customized fashion specific to you, heat and kill the prostate cancer tissue while protecting important surrounding body parts that are important for preserving urinary and sexual function. Minimally invasive here means that the procedure is performed through natural openings in your body (the urethra) instead of creating larger openings like traditional surgery or minimally invasive surgery.
The purpose of this research study is to:
* Test whether the TULSA Study Procedure preserves or improves your quality of life (urinary, bowel and sexual functions) at 12 months post-study treatment compared to standard of care (radical prostatectomy).
* Test how many subjects who undergo the TULSA Study Procedure are free from treatment failure by 3 years post-study treatment compared to subjects who undergo the standard of care (radical prostatectomy). Treatment failure is defined as undergoing other additional prostate cancer treatments, spreading of cancer or death caused by cancer.
About 201 subjects will participate in this study with 67 randomly assigned to the radical prostatectomy group and 134 randomly assigned to the TULSA procedure group. Patients will have a 1 in 3 chance of being assigned to the radical prostatectomy group and a 2 in 3 chance of being assigned to the TULSA group. Following treatment, patients will be followed up for 10 years.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- Male
- Target Recruitment
- 201
- Male
- Age 40 to 80 years, with >10 years life expectancy
- NCCN (favorable and unfavourable) intermediate-risk prostate cancer on biopsy acquired within last 12 months
- Stage ≤cT2c, N0, M0
- ISUP Grade Group 2 or 3 disease on TRUS-guided biopsy or in-bore biopsy
- PSA ≤20ng/mL within last 3 months
- Treatment-naïve
- Planned ablation volume is < 3 cm axial radius from urethra on mpMRI acquired within last 6 months
- Inability to undergo MRI or general anesthesia
- Suspected tumor is > 30 mm from the prostatic urethra
- Prostate calcifications > 3 mm in maximum extent obstructing ablation of tumor
- Unresolved urinary tract infection or prostatitis
- History of proctitis, bladder stones, hematuria, history of acute urinary retention, severe neurogenic bladder
- Artificial urinary sphincter, penile implant, or intraprostatic implant
- Patients who are otherwise not deemed candidates for radical prostatectomy
- Inability or unwillingness to provide informed consent
- History of anal or rectal fibrosis or stenosis, or urethral stenosis, or other abnormality challenging insertion of devices
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method Efficacy endpoint - proportion of patients free from treatment failure 36 months post-treatment Compare the proportion of patients experiencing treatment failure, between the 2 arms. Treatment failure is defined as delivery of any additional intervention for prostate cancer (local or systemic, including adjuvant therapy), or metastatic disease, or prostate cancer-specific death.
Safety endpoint - proportion of patients who maintain both urinary continence and erectile potency 12 months post-treatment Compare preservation of urinary continence and erectile potency, between the 2 arms. Urinary continence is defined as 'pad-free' (0 pads/day) (per EPIC question 5) and erectile potency is defined as erection firmness sufficient for penetration (per IIEF question 2).
- Secondary Outcome Measures
Name Time Method Biochemical failure endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years Compare the proportion of patients with biochemical failure between the two arms. Biochemical failure is defined as PSA≥ 0.2 ng/mL for the RP arm or PSA nadir plus 2 ng/mL for the TULSA arm (adapted from Phoenix criteria).
Metastases-free survival endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years Compare the proportion of patients who are free from metastatic disease between the 2 arms, based on imaging.
Prostate cancer-specific survival endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years Compare the proportion of patients who die of prostate cancer between the 2 arms.
Penile length endpoint At 1 month and 12 months post-treatment Compare the change in penile length from baseline to after treatment, between the 2 arms, as measured by the study doctor.
Histological failure endpoint At 12 month post treatment, and also at 24 months post treatment for patients who undergo a repeat TULSA Compare the proportion of patients who have clinically significant disease (defined as ISUP Grade Group 2 or higher) between the two arms.
mpMRI endpoint (for Tulsa arm only) At 12 month post treatment, and also at 24 months post treatment for patients who undergo a repeat TULSA Characterize the effect of the TULSA Procedure ablation on diagnostic multi-parametric MRI, determined using PI-RADS V2 score, compared to baseline.
Overall survival endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years Compare the proportion of patients who die of any cause, between the 2 arms.
Blood loss endpoint During the procedure and immediately after the procedure Compare the volume of blood lost between the two arms during treatment.
Salvage-free survival endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years Compare the proportion of patients who are salvage free, between the two arms. Salvage-free survival is defined as freedom from any salvage treatments after the assigned treatment, for both RP arm and TULSA arm. 1 repeat TULSA does not count as Salvage.
Surgical complications endpoint At the following study visits post treatment: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5 years Compare the frequency and severity of all adverse events between the 2 arms, evaluated by attribution and reported in accordance with Clavien-Dindo classification.
Penile rehabilitation endpoint At the following study visits post treatment: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5 years Compare the proportion of patients who undergo penile rehabilitation between the 2 arms (penile rehab includes implant insertion, medication/injection, traction or pump device).
NRS Endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24, and 36 months. Compare Numerical Rating Scale (NRS) ratings (which measures pain intensity), between the two arms at follow up, referenced to baseline. 0 indicates no pain and 10 indicates worst possible pain.
Inpatient hospital stay endpoint Immediately after the procedure Compare the length of inpatient stay between the two arms.
Transfusion volume endpoint During the procedure and immediately after the procedure Compare the volume of transfused blood between the two arms during treatment.
IPSS Endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years Compare International Prostate Symptom Score (IPSS) scores (for urinary function), between the two arms at follow up, referenced to baseline. Minimum score=0, Maximum score=35. Higher scores indicate a worse outcome.
EPIC Endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years Compare (Expanded Prostate Cancer Index Composite) EPIC scores (for domains of urinary, sexual, bowel, and hormonal function), scored from 0 (worst) to 100 (best) between the two arms at follow up, referenced to baseline.
EQ-5D-5L Endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24, and 36 months. Compare the EQ-5D-5L scores (which measures quality of life), between the two arms at follow up, referenced to baseline. Responses are coded as single-digit numbers expressing the severity level selected in each dimension (Mobility, self-care, usual activities, pain/discomfort and anxiety expression), where level 1 indicates no problem and level 5 indicates extreme problem.
IIEF-15 Endpoint At each visit post treatment throughout the total study follow up: 1, 3, 6, 9, 12, 18, 24 month, and 3, 4, 5, 6, 7, 8, 9, 10 years Compare International Index of Erectile Function (IIEF-15) scores (for domains of sexual function) between the two arms at follow up, referenced to baseline. Low scores indicate a worse outcome.
Related Research Topics
Explore scientific publications, clinical data analysis, treatment approaches, and expert-compiled information related to the mechanisms and outcomes of this trial. Click any topic for comprehensive research insights.
Trial Locations
- Locations (22)
Arizona State Urological Institute
🇺🇸Chandler, Arizona, United States
East Valley Urological Center
🇺🇸Mesa, Arizona, United States
Investigate MD
🇺🇸Scottsdale, Arizona, United States
Atlantic Urology Medical Group
🇺🇸Long Beach, California, United States
Urology Group of Southern California
🇺🇸Los Angeles, California, United States
University of California, Los Angeles
🇺🇸Los Angeles, California, United States
Comprehensive Urology Medical Group
🇺🇸Los Angeles, California, United States
Alarcon Urology Center
🇺🇸Montebello, California, United States
Pasadena Urological Medical Group
🇺🇸Pasadena, California, United States
Stanford Cancer Center
🇺🇸Stanford, California, United States
Scroll for more (12 remaining)Arizona State Urological Institute🇺🇸Chandler, Arizona, United States